5430 Dixie Hwy. Saginaw, Michigan 48601 Phone (989) 753-4405 Fax (989) 753-2493 For fast credit review please print out this form, complete it, and FAX it back to (989) 753-2493.
CREDIT APPLICATION
BUSINESS/COMPANY	__________________________	TELEPHONE	__________________________
ADDRESS	__________________________	POST OFFICE BOX	__________________________
CITY/STATE/ZIP	__________________________	FAX	__________________________
TYPE OF BUSINESS	_______________________	SIC CODE_____________	ESTABLISHED_____________
CORPORATION_________	PARTNERSHIP	__________	SOLE OWNERSHIP_________
OFFICERS/CONTACTS:
PRESIDENT	__________________________	VICE PRESIDENT	__________________________
ACCOUNTS PAYABLE	__________________________	PURCHASING	__________________________
ANTICIPATED MONTHLY CREDIT REQUIRED $
CURRENT FINANCIAL STATEMENT ATTACHED?
BANK REFERENCE:	__________________________	TELEPHONE	__________________________
CITY/STATE/ZIP	__________________________	ACCOUNT NO.	__________________________
CONTACT PERSON	__________________________	TYPE OF ACCOUNT	__________________________
BUSINESS REFERENCE:	__________________________	TELEPHONE	__________________________
ADDRESS	__________________________	FAX	__________________________
CITY/STATE/ZIP	__________________________	ACCOUNT NO.	__________________________
BUSINESS REFERENCE:	__________________________	TELEPHONE	__________________________
ADDRESS	__________________________	FAX	__________________________
CITY/STATE/ZIP	__________________________	ACCOUNT NO.	__________________________
BUSINESS REFERENCE:	__________________________	TELEPHONE	__________________________
ADDRESS	__________________________	FAX	__________________________
CITY/STATE/ZIP	__________________________	ACCOUNT NO.	__________________________
SIGNATURE/TITLE	__________________________	DATED	__________________________